Results of Open Wound Technique in the Treatment of Post-Sequestrectomy Dead Space

BACKGROUND AND METHOD. Severe chronic osteomyelitis with variable outcomes is still common among children in developing nations. There has been no consensus on the optimal method of treatment. We therefore prospectively evaluated the rates of wound healing and recurrence following open wound treatment of post-sequestrectomy dead spaces in 30 patients with haematogenous chronic osteomyelitis of the tibial shaft at the King Orthopaedic Clinic; Ekpoma; Edo State; Nigeria; between January 2001 and December 2005. Thirty similar patients whose post-sequestrectomy dead spaces were treated by closed wound technique formed the control group. Both groups were subjected to standard methods of perioperative management. Saucerisation; sequestrectomy and curettage were the cornerstones of surgical therapy. The wounds were primarily either left open (study group) or closed (control group). The rates of wound healing and recurrence were used to assess the outcome of treatment. The chi-squaretest was used for statistical analysis. RESULT. The median age was 13 years; with a range of 6 - 60 years. Staphylococcus aureus was the organism most commonly associated with chronic osteomyelitis. Rates of wound healing and recurrence in the study group were significantly better than in the control group (p0.05); eventhough it took a relatively longer period to achieve healing with the open method of treatment. The follow-up period ranged from 1 to 5 years; with a median of 2 years.CONCLUSION. We observed that the results of the open method of treating post-sequestrectomy dead spaces were good; and we advocate its use in resource-poor settings

Infections osteo-articulaires de l'enfant: notre experience en chirurgie pédiatrique au CHU de Yopougon

Nous avons realise une etude retrospective sur une periode de 5 ans (du 1er janvier 2000 au 31 decembre 2004). Elle a concerne 106 cas d'infections osteo-articulaires observes dans le service de chirurgie pediatrique du C.H.U de Yopougon a Abidjan. Notre etude a pour but de faire un plaidoyer en faveur d'un diagnostic precoce des infections osteo-articulaires. Nous insistons sur: -La frequence moyenne de ces pathologies osteo-articulaires au service de chirurgie pediatrique du C.H.U de Yopougon. 9;9pour cent des hospitalises soit 21 cas par an. -La tranche d'age de 11 a 15 ans est apparue la plus touchee par l'osteomyelite (75pour cent). -la tranche d'age de 0 a 2 ans est apparue la plus touchee par l'arthrite et l'osteo-arthrite (84;9pour cent). -Les I.O.A touchent les individus quel que soit le sexe mais une predominance masculine (62;3pour cent). -Les infections osteo-articulaires touchent les sujets quel que soit leur etat nutritionnel. -Aucune porte d'entree n'est trouvee dans la majorite des cas. -La notion de traumatisme et d'infection O.R.L. sont souvent evoquees avant le debut de la maladie. -Le traitement entrepris a domicile et dans une formation sanitaire avant l'hospitalisation est cause d'un retard de diagnostic. -Les articulations les plus touchees sont: la hanche (30 fois); le genou (18 fois) et l'epaule (18 fois). -Les os les plus atteints sont le femur (39;4pour cent) ; le tibia (29;5pour cent) et l'humerus (19;7pour cent). -Le type d'hemoglobine: les infections osteo-articulaires touchent les sujets quels que soit le type d'hemoglobine. -Les resultas therapeutiques quel que soit la nature du traitement: *58;8pour cent de guerisons sans sequelle pour l'arthrite ;*45;2pour cent de guerisons sans sequelle pour l'osteo-arthrite ;*45;5pour cent de guerisons sans sequelle pour l'osteomyelite aigue ;*21;1pour cent de guerisons sans sequelle pour l'osteomyelite chronique. Nous faisons des propositions pour une meilleure prise en charge; a la fois precoce; et correcte; de ces enfants dans le but de prevenir les complications osteo-articulaires qui sont les sources de graves sequelles chroniques et des impotences fonctionnelles motrices

Postoperative osteomyelitis after clean orthopaedic operations at Maputo Central Hospital

The frequency of operative sepsis to be considered when planning whether or not operative management should be undertaken. An operative approach is justified only if the risks of osteomyelitis are minimal. The study was of 307 patients who underwent 'clean' operation on bones in 1987. Adequate records were available for 272; and of these 38 patients developed osteomyelitis